Effect of Transcatheter Pulmonary Valve Implantation on Short-Term Right Ventricular Function as Determined by Two-Dimensional Speckle Tracking Strain and Strain Rate Imaging

Moiduddin, Nasser; Asoh, Kentaro; Slorach, Cameron; Benson, Leland N.; Friedberg, Mark K.

doi:10.1016/j.amjcard.2009.05.018

Cited by 58 publications

(46 citation statements)

References 28 publications

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“…Several groups, including our own, have shown favorable short-term results after PPVI with the Melody valve. 1,2,[16][17][18][19] Bonhoeffer and colleagues, pioneers in the use of this technology, reported a series of 155 patients followed echocardiographically for a median 28.4 months (2.4 years) after valve implantation, 5 documenting a significant initial reduction in RVSp, pressure gradient across the pulmonary valve, improved valvar competence, and a 70% freedom from reintervention at 70 months. Our series further details the trajectory of these outcomes in the intermediate term (mean 4.5±1.9 years, median 4.2 years) from a large cohort with a wide age range at time of implantation.…”

Section: Discussionmentioning

confidence: 99%

Percutaneous Pulmonary Valve Implantation: 5 Years of Follow-Up

Borik

Crean

Horlick

et al. 2015

Circ: Cardiovascular Interventions

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Background-Percutaneous pulmonary valve implantation (PPVI) is a safe, less invasive alternative to surgical valve replacement for the congenital heart disease patient with right ventricular (RV) outflow tract dysfunction. The aim of this study was to determine whether reverse RV remodeling after PPVI was persistent in the longer term and whether timing of PPVI influenced outcomes. Methods and Results-Consecutive patients from the pediatric and adult congenital heart disease programs were enrolled.Cardiac MRI, echocardiography, metabolic exercise testing, chest radiography, and hemodynamics before intervention were compared with repeated follow-up measurements to assess changes over time. Fifty-one patients (including 23 patients <16 years old) were followed for a mean 4.5±1.9 (0.9-6.9) years after implantation, 59% of patients having available comparative cardiac MRI data. Freedom from any reintervention was 87% and 68% at 3 and 5 years, and freedom from surgery was 90% at 5 years. For every decade younger at implantation, there was an increase of 3.9%±1.0% in cardiac MRI left ventricular ejection fraction (P<0.001) and 2.4±0.9 mL/kg/min in maxVO 2 (P=0.005) and a decrease of 0.7±0.2 cm in RV end-diastolic dimension (P<0.001) after intervention. Younger patients displayed an additional decline in the RV/left ventricular end-diastolic volume ratio (P=0.05) and trended toward improved RV ejection fraction in late follow-up (50%±7% versus 41%±12%, P=0.07). Conclusions-This is the largest series to show that PPVI at a younger age yields incremental improvements in RV size and maximum oxygen consumption. Early valve implantation is associated with better RV function and should be considered in management planning for this population. (Circ Cardiovasc Interv. 2015;8:e001745.

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Section: Discussionmentioning

confidence: 99%

Percutaneous Pulmonary Valve Implantation: 5 Years of Follow-Up

Borik

Crean

Horlick

et al. 2015

Circ: Cardiovascular Interventions

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“…6,[23][24][25] For strain analysis in this cohort, the use of CMR offers advantages compared with echocardiography. Most of these patients are adults with poor acoustic windows secondary to their body size and prior surgical procedures.…”

Section: Discussionmentioning

confidence: 99%

Impact of Transcatheter Pulmonary Valve Replacement on Biventricular Strain and Synchrony Assessed by Cardiac Magnetic Resonance Feature Tracking

Harrild

Marcus

Hasan

et al. 2013

Circ: Cardiovascular Interventions

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Background-Transcatheter pulmonary valve (TPV) replacement is an emerging therapy intended to restore pulmonary valve function in patients with right ventricular outflow tract conduit dysfunction; the impact of this technique on ventricular strain and synchrony is not known. Methods and Results-Cardiac magnetic resonance and ECG data acquired at 1 center as part of the US Melody TPV trial were analyzed. Biventricular strain and mechanical synchrony measurements were made based on short-axis and 4-chamber steady-state free precession images using feature tracking software. Post-versus pre-TPV replacement findings were compared for all patients (n=31) and subgroups with predominant pulmonary regurgitation (n=13) or stenosis (n=18). Most patients had tetralogy of Fallot (18/31). After TPV replacement, left ventricular (LV) circumferential strain increased for the whole cohort (P<0.001) and both subgroups (pulmonary regurgitation P=0.01; pulmonary stenosis P=0.02). LV longitudinal strain increased for the whole cohort (P=0.02) and pulmonary regurgitation subgroup (P=0.05); circumferential right ventricular strain increased for the pulmonary stenosis group only (P=0.05). LV longitudinal synchrony improved significantly in the pulmonary regurgitation group (maximum wall delay P=0.03; cross-correlation delay P=0.01). Electric measures of synchrony did not improve. Conclusions-In Harrild et al Impact of TPV Replacement 681are no reports of any kind of its impact on synchrony of the left ventricle (LV) or RV. The goal of the present study was to quantify the impact of TPV replacement on indices of RV and LV strain and synchrony in patients with dysfunctional RVOT conduits using high-quality CMR images. Methods Study DesignThis was a retrospective cohort study of patients undergoing placement of a Melody TPV in the setting of a dysfunctional RVOT conduit designed to investigate changes in ventricular mechanics based on CMR images before and after pulmonary valve implantation. This study was performed according to a protocol approved by the Committee for Clinical Investigations at Boston Children's Hospital, Boston, MA. PatientsPatients included in this study comprised a subset of the cohort enrolled at our center as part of the multicenter US Melody TPV investigational device exemption (IDE) trial. Briefly, the IDE trial was designed to investigate the safety, procedural success, and short-term effectiveness of Melody valve placement in patients with a biventricular circulation and a dysfunctional RVOT conduit. Study protocols and short-term outcomes have been previously reported. 4,5 As part of their participation in the trial, patients had clinical, ECG, and CMR data collected before and 6±2 months after TPV replacement. Patients were included in the present study if they had high-quality CMR images for analysis both pre-and post-TPV replacement performed between 2007 and 2010.Patients were first analyzed as an entire cohort, and then dichotomized into 2 groups: predominant pulmonary stenosis (PS; RVOT peak systolic e...

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“…We believe Lagrangian strain offers the advantage, over myocardial segment velocity measurements, of recognition of segmental deformation abnormalities, independent from translation effects of adjacent normal contracting segments. It is possible that speckle tracking could document alteration in myocardial function following fetal valvuloplasty as an improvement of myocardial deformation abnormalities in CHD [17,18,19,26], valvular heart disease [20], and systemic or pulmonary hypertension [21], following successful treatment [22,23,24]. Abnormal ventricular loading conditions in fetal life are likely to exert important developmental effects compared to their postnatal course [12,13] and early recognition of abnormal loading conditions, before irreversible fetal heart changes occur, may guide appropriate timing of fetal intervention [27].…”

Section: Discussionmentioning

confidence: 99%

Myocardial Strain Abnormalities in Fetal Congenital Heart Disease Assessed by Speckle Tracking Echocardiography

Germanakis¹,

Matsui

Gardiner

2012

Fetal Diagn Ther

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Objectives: To compare myocardial deformation patterns in fetuses with congenital heart disease (CHD) with our reference range using speckle tracking echocardiography. Methods: We prospectively stored and analyzed 4-chamber loops of 28 fetuses with CHD (median gestation 27 weeks, range 20.9–37.0). The peak longitudinal left (LVs) and right (RVs) ventricular free wall Lagrangian strain and LV/RV strain ratio were measured from Syngo VVI software- (Siemens) derived original coordinates. Strain values from the first examination were compared with normative data from the same population using ANOVA with post hoc tests and serial examinations described in 14 fetuses. Results: Simple shunt lesions (0.82) and shunts with pulmonary stenosis or atresia (0.93) had reduced mean LV/RV strain ratios compared to normal fetuses (1.01; 95% CI 0.97–1.05). Fetuses with hypoplastic left heart had the lowest (0.29), and those with Ebstein the highest (1.55), LV:RV ratio. Serial measurements showed increased LVs in aortic coarctation and aortic stenosis, but not in one developing important mitral regurgitation. Increased right ventricular loading in a fetus developing pulmonary regurgitation was associated with increasing RVs. Conclusions: Myocardial strain reflects the changing physiology of fetal CHD. Speckle tracking might be a useful tool to study the progress of myocardial function in affected fetuses.

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Effect of Transcatheter Pulmonary Valve Implantation on Short-Term Right Ventricular Function as Determined by Two-Dimensional Speckle Tracking Strain and Strain Rate Imaging

Cited by 58 publications

References 28 publications

Percutaneous Pulmonary Valve Implantation: 5 Years of Follow-Up

Percutaneous Pulmonary Valve Implantation: 5 Years of Follow-Up

Impact of Transcatheter Pulmonary Valve Replacement on Biventricular Strain and Synchrony Assessed by Cardiac Magnetic Resonance Feature Tracking

Myocardial Strain Abnormalities in Fetal Congenital Heart Disease Assessed by Speckle Tracking Echocardiography

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